Psychopharmacology Case Study

Psychopharmacology Case Study

A keen analysis of a case helps the advanced practice nurse accurately diagnose and manage a patient’s disorder. Rays’ disease, schizoaffective disorder, is when an individual experiences schizophrenia and bipolar mood disorder symptoms. It is potentially life-threatening if not well treated.

Psychopharmacology Case Study

The pathophysiology of the disease is unclear, and researchers associate the disorders with imbalances in dopamine, serotonin, and norepinephrine levels. Research studies show that individuals with schizophrenia and schizoaffective disorder have varied levels of these neurotransmitters.

Some research studies show that progressive brain white matter abnormalities, especially in the right lentiform nucleus, left temporal gyrus, and right precuneus, are associated with schizophrenia and schizoaffective disorder diagnosis (Joshua & Saadabadi, 2022). Significant brain volume changes, especially in the hippocampal regions, and deformations in the medial and lateral thalamic areas have also been reported. The disease has a high genetic predisposition among first-degree patients.

Sertraline was not a good drug choice for depression for Ray when he was in school. Sertraline is FDA approved to treat obsessive-compulsive disorder in children above six years. However, fluoxetine and escitalopram are FDA-approved drugs for depression for managing depression in pediatrics (Strawn et al., 2019).

Haldol is an antipsychotic medication primarily used in schizophrenia to treat symptoms such as agitation, hallucinations, tics, delirium, and mania in bipolar disorder. It is a drug of choice in the acute phase of schizophrenia. It was the drug of choice for this patient when he was first admitted.

Choice Medications for Ray

Paliperidone 6mg p.o OD. Disp 90 RF x 1

Paliperidone is the only FDA-approved antipsychotic medication for managing schizoaffective disorder (Wy & Saadabadi, 2022). It also helps replace Haldol, which Ray does not like and has reported poor drug adherence

Aripiprazole 10mg PO OD. Dis 90 RF x 1

Aripiprazole is an antipsychotic medication used alone or with a mood stabilizer to treat bipolar depression. The drug will help relieve psychotic symptoms and reduce bipolar depression (Qian et al., 2021). Regular review of the medications (every two weeks) to assess for therapy effectiveness and possible side effects is necessary

Lithium 300mg PO TID. Disp 30 RF x 1

Lithium is a mood stabilizer that will address bipolar mania. The drug is FDA-approved and is effective as monotherapy or combined therapy in acute manic episodes and maintenance therapy for bipolar disorder (Wy & Saadabadi, 2021). The dose should be reviewed and updated regularly depending on the serum levels and patient response to the drug.

Future Medications

Hydrochlorothiazide 50mg PO OD. Disp 30 RF x 1

The medications prescribed may positively affect Ray’s symptoms and lead to a better-quality life. In the future, there will be no need for other therapies, maybe dose adjustments depending on the side effects and effectiveness of the medications.

Diabetes insipidus is expected in about 20-40% of patients on lithium and thiazide diuretics, which are FDA-approved drugs for the condition (Nath & Gupta, 2022). Hydrochlorothiazide is the most potent and effective drug in this class. Hydrochlorothiazide 50mg orally daily will help manage the diabetes insipidus

Patient Education

Patient education for Ray will entail the specific drugs and an overview of their therapeutic use and doses. The education will also emphasize the importance of medication adherence to treatment and rehabilitation. Referral to a support group for individuals with schizophrenic disorder will also help him manage the condition.

Wy and Saadabadi (2021) show that emotional support and encouragement will help show compassion and increase drug adherence and positive living. Another intervention is teaching him skills that increase self-care and independence, such as forming routines and opting for supported employment.

Age and chronicity of the disease were the major factors influencing the prescription choices. Age affects the drug choice and dosage and the goals of the interventions (acute or long-term also dictate the choice of therapy and dosage for the patients). There are no cultural factors affecting prescription choices identified.

References

  • Nath, M., & Gupta, V. (2021). Mood Stabilizers. In StatPearls [Internet]. StatPearls Publishing.
  • Qian, L., Xuemei, L., Jitao, L., Yun’Ai, S., & Tianmei, S. (2021). Dose-Dependent Efficacy of Aripiprazole in Treating Patients With Schizophrenia or Schizoaffective Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Psychiatry12, 717715. https://doi.org/10.3389/fpsyt.2021.717715
  • Strawn, J. R., Poweleit, E. A., & Ramsey, L. B. (2019). CYP2C19-guided escitalopram and sertraline dosing in pediatric patients: a pharmacokinetic modeling study. Journal of Child and Adolescent Psychopharmacology29(5), 340-347. https://doi.org/10.1089/cap.2018.0160
  • Wy, T. J. P., & Saadabadi, A. (2021). Schizoaffective Disorder. In StatPearls [Internet]. StatPearls Publishing.